COUNTY PART OF CARE COORDINATION PROJECT

San Diego County would be one of the initial participants in a proposed three-year demonstration project by the California Department of Health Care Services aimed at improving the coordination of care for low-income seniors and people with disabilities who are dually eligible for Medicare and Medi-Cal.

Los Angeles, Orange and San Mateo counties also would be among the first of up to 10 counties that could take part in the demonstration project, the agency said.

“The goal is to design a seamless system that helps dual-eligible beneficiaries get the health care services they need and improve health outcomes in a more fiscally efficient manner,” said DHCS director Toby Douglas.

There are about 1.1 million people in California enrolled in both Medicare and Medi-Cal. They are among the state’s highest-need and highest-cost users of health care services, accounting for nearly 25 percent of Medi-Cal spending.

The proposed project would enroll a portion of California’s dual-eligible beneficiaries into integrated care delivery models. An estimated $678.8 million in general fund savings is expected in fiscal 2012-13, increasing to $1 billion in 2013-14, according to the agency.

Under the demonstration project, selected health plans would receive a blended monthly payment from Medicare and Medi-Cal to provide their enrollees all needed services. Beneficiaries would have a single health plan membership card and a care team to help coordinate their services.

The project would be funded by the Affordable Care Act and requires the approval of the federal Centers for Medicare & Medicaid Services.

Pending approval from CMS, the state would begin notifying beneficiaries of changes due to the proposed demonstration project this fall. ﻿Enrollment would begin in January. Beneficiaries can choose to keep their Medicare benefits separate from this integration, but those who do not opt out of the project will be enrolled on a phased-in basis throughout 2013.